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Hair is one of the defining characteristics of human beings. Hair is a protein filament that grows from follicles found in the dermis. Keratin is the source of hairs and nails. There are different kinds of hair diseases in humans like Alopecia Areata, Congenital Hypotrichosis, Telogen Effluvium, Scarring Alopecia, Anagen Effluvium, etc., in which Alopecia Areata is the most common. It is the subject of research for early identification. People typically lose so many hairs per day. Hair loss is a very common problem nowadays seen in more or less in every age group, Alopecia is similar to hair loss. The reason behind hair loss is some vitamin deficiency that helps to build the sources like keratin. At the age of 32–36 near 40% people are facing the problem of hair loss. In the dataset there are 609 images in which 310 images of normal hair and 299 images which are infected from Alopecia Areata. In this study, we used pre-trained models (VGG-16, VGG-19, SqueezeNet and Inception-V3) for feature extraction. The dataset is splitted into the ratio of 7:3 in which 70% and 30% used as training data and testing data, respectively. Then, apply the proposed algorithms like ANN, SVM, logistic regression, Naive Bayes and get the maximum 98.3% accuracy.

Telogen effluvium (TE) is one of the most common form of hair loss in women. Many triggers have been identified, as stress, drugs, trauma, endocrine disease, nutritional deficiencies, and febrile states. We report three cases of TE occurred after severe Sars‐Cov‐2 infection and provide our clinical management, according to Sars‐Cov‐2 hygiene measures. Only one case report has been found in the literature associating anagen effluvium during severe Sars‐Cov‐2 infection. Other studies reported the exacerbation of a preexisting TE, correlated to the stress of lockdown. In our cases, patients never had a TE diagnosis before and did not report previous evident hair loss. TE can be associated with post severe Sars‐Cov‐2 infection. From our revision of the literature, this is the first case‐series describing TE in post severe Sars‐Cov‐2 patients. Further studies are needed to evaluate the relationship between TE and Sars‐Cov‐2 infection.

Albendazole is a drug commonly used for treating many parasitoses. The primary mechanism of action is inhibition of microtubule polymerization binding to β-tubulin, similar to colchicine as a microtubule formation inhibitor. It is reasonable that these two antimitotic drugs can cause side effects such as alopecia and cytopenia by a similar mechanism. In the literature, only one albendazole-induced anagen effluvium has been reported. This article presents two cases of anagen effluvium that developed 2 weeks after oral albendazole administration, summarizes all cases reported to date, and offers recommendations for a diagnostic approach.

New COVID-19 skin manifestations continue to be described. We present a patient with COVID-19 related anagen effluvium. The patient was treated with and responded to low dose systemic steroids to treat an accompanying extensive COVID-19-related urticaria and maculopapular rash.

There are two therapeutic options for patients with cancer: radiotherapy and chemotherapy. The latter is subdivided into conventional chemotherapy and targeted chemotherapy. Both categories of chemotherapy treatment induce side effects, although these are more frequent with conventional chemotherapy than with targeted chemotherapy. These side effects are frequently affecting the skin, hair and nails. In this review, all categories of chemotherapeutical drugs are considered and the adverse events related with each drug are described. The most severe events are hypersensitivity reactions, which can endanger the patient’s life. Besides, the most common cutaneous reactions will be maculopustular or papulopustular rashes, hand and foot skin syndrome, edema, erythema, hyperpigmentation disorders or photosensitivity reactions. Stomatitis is also frequent on oral mucosa. Regarding hair, anagen effluvium and alopecia are frequently observed, whilst the nails are also affected by many of these treatments. This review describes these side effects and their symptoms and diagnosis, giving tips for prevention and treatment of the same.

Medical conditions involving hair are typically managed by a dermatologist. However, a significant psychosocial association has been found both in the development of hair conditions through primary pathologic involvement and as secondary comorbidity. Trichopsychodermatology is an emerging field aiming to better understand the psychiatric and psychosocial impacts of disorders involving hair. Trichotillomania or hair-pulling disorder, alopecia areata, telegenic effluvium, anagen effluvium, and cicatricial alopecia represent common conditions within trichopsychodermatology. A lack in awareness, knowledge, and training of the field exists, which can act as a barrier for improving patient outcomes. This review provides a holistic understanding of specific psychotrichologic conditions that healthcare providers may encounter in order to facilitate the process of developing high-quality future therapeutic interventions.

Background Anagen effluvium with reversible scalp alopecia is a known side effect of chemotherapy. However, there are an increasing number of reports in the literature documenting permanent alopecia in patients treated with taxanes. Objective We sought to describe the clinicopathologic features in breast cancer patients who underwent treatment with taxanes and adjuvant hormonal chemotherapy. Methods We reviewed the clinical and histopathologic information of a cohort of 10 patients treated with taxanes and adjuvant hormonal chemotherapy. Results We have observed 3 types of clinical patterns of alopecia (types A, B, and C), and have validated the histopathologic features showing alopecia areata–like and female pattern hair loss. Limitations The study was based on a small sample size and retrospective retrieval of clinical information and histopathologic review of posttreatment slides. Conclusions We hypothesize a clinicopathologic model of hair follicle cycle disruption in response to the chemoinflammatory and hormonal insults to the hair follicles resulting in permanent alopecia. Clinicopathologic correlation is paramount to the understanding of the morphobiologic pathways in chemotherapy-induced alopecia caused by taxanes and adjuvant hormonal treatment.

Anagen effluvium develops because of disturbances in the hair follicle cycle, leading to acute and severe hair loss in humans. The objective of this study was to establish a mouse model of anagen effluvium by 5-bromo-2'-deoxyuridine (BrdU) treatment, and evaluate the pathological changes and underlying mechanisms. We treated 9-10-day-old pups and 3-7-week-old C57BL/6 mice with BrdU. After successfully inducing hair loss in the neonatal pups, microscopic, immunohistochemical and flow cytometry analyses were conducted. BrdU induced early onset alopecia in neonates and caused epidermal thickening and hair shaft breakage. BrdU appeared to incorporate the CD326-positive keratinocyte layer and induced p53-related apoptosis. Keratinocyte apoptosis caused immune cell infiltration in the dermal region; M2 macrophages and neutrophils were dominant. The BrdU-induced hair loss was dose-dependent, and alopecia was visible at a dose range of 25-200 μg/g bodyweight. The BrdU-induced anagen effluvium mouse model is novel and easily established by administrating four simple BrdU injections to pups; these mice showed synchronized onset of alopecia symptoms with little individual variation. Moreover, this model showed an alopecia phenotype similar to that of human anagen effluvium with acute, severe and widespread hair loss.

Plica polonica (plica neuropathica) is an uncommon entity characterized by irreversible twisting and matting of hair resulting in a hard impermeable mass of keratin. Although the exact mechanism is not fully understood, it has been attribute to longitudinal splitting or weathering of hair shaft due to vigorous friction and frequent use of harsh shampoos and harsh cleansers and/or due to keeping long hair with poor hair care or neglect, parasitic infection. We describe an unusual case of plica polonica occurring in a patient of lung adenocarcinoma on chemotherapy and review the literature. Anagen effluvium due to chemotherapy (paclitaxel and carboplatin) and use of an uncustomary shampoo by the patient are the causative factors for matting of the hair.

BACKGROUND Diffuse alopecia areata (DAA) often leads to a complete hair shedding within a few months. OBJECTIVE To explore features and mechanisms underlying DAA. MATERIALS AND METHODS Scalp and hair root dermoscopy were conducted on 23 DAA patients throughout the disease process, 20 patchy Alopecia areata patients, 23 acute telogen effluvium (ATE) patients and 10 normal controls. Histopathology was also evaluated. RESULTS We found almost all hair roots were anagen in early stage DAA in 18 patients (18/23, 78.3%) within the first 4-8 weeks after hair loss onset. Anagen effluvium (~4 weeks) was followed by catagen (~4 weeks) and then telogen/exogen (~8 weeks) effluvium with overlap. Hair root and proximal hair shaft depigmentation was more prominent in later DAA disease stages. Black dots, exclamation mark hairs and inconsistent thickness of hair shafts were found more often in early than later DAA (Ps

Ablative surgery for skin cancer of the face can often leave patients with significant deformities. These disfigurements can include loss of hair in conspicuous areas such as the eyebrows, leaving the patients with unsightly facial asymmetry. Eyebrow transplantation serves to address this issue; however, it has often been discouraged in patients who are destined to receive radiotherapy to the cutaneous area in question. This is due to the anagen effluvium effect of radiation therapy on hair follicles. We present a case in which the transplanted eyebrow hair follicles survived the deleterious effects of radiotherapy, leaving the patient with a symmetrical and aesthetically satisfactory eyebrow appearance.

Post-surgical effluvium or shock loss is a shedding of the existing hair in and around the transplant area following a hair restoration procedure. Either telogen or anagen effluvium in response to peri-surgical injury is assumed; however, the exact cause of post-surgical effluvium has not been understood. Recently, we performed a pilot control study in order to evaluate the effect of epinephrine in tumescent anesthesia at the recipient area on post-surgical effluvium. Our study suggested that epinephrine is not the main factor that influences post-surgical effluvium at the recipient area. All known risks should be carefully avoided during the pre-, intra-, and post-surgical period. This complication should be carefully discussed with the patient prior to surgery to avoid dissatisfaction.

Anagen effluvium (AE) is a type of alopecia with hair loss during the growth phase of a hair follicle and is most often associated with cytotoxic chemotherapy. This report describes a case of AE in a critically ill 2-year-old boy who developed cardiorespiratory failure requiring extracorporeal membranous oxygenation. We postulate that the combination of hypotension and hypoxia with subsequent reperfusion triggered an apoptotic cascade in the hair matrix, resulting in AE.

Hair loss is a common complaint, both in men and women, and use of prescription medications is widespread. When there is temporal association between the onset of hair loss and commencement of a medication, the medication is commonly thought to have caused the hair loss. Many reports in literature that attribute hair loss to particular medications have not adequately explored the nature of the hair loss and excluded other potential unrelated causes of hair loss.

The diagnosis and management of drug-induced hair and nail disorders in the clinic presents a unique challenge for the physician. Not only must the physician recognize the trigger and manage the symptoms but also consider the influence these disorders have on the patient's quality of life. This article describes the various types of drug-induced hair and nails disorders, and discusses the clinical recognition, pathophysiology and possible management options.

Alopecia, a frequently reported problem, severely impacts the quality of life of patients and is often associated with loss of confidence and low self-esteem. Several conditions such as telogen effluvium (TE), anagen effluvium, diffuse type of alopecia areata, female pattern hair loss, hair shaft abnormalities, loose anagen hair syndrome, and congenital atrichia or hypotrichosis are associated with hair loss. The actual prevalence rate of TE is not reported since most cases are subclinical in nature. Further, since women get more distressed by hair fall and promptly seek treatment, they tend to be over-represented. However, both genders can suffer from this condition if triggering factors are present. This consensus paper was developed by taking into account opinions of renowned experts in the field and is hoped to serve as an evidence-based platform for selecting efficacious and safe therapy for patients with TE. This review presents a synopsis of the key opinions of experts on all aspects of treatment and effective management of this condition.

Noninflammatory, nonpruritic alopecias are uncommonly encountered in the horse. Alopecia areata, an apparently autoimmune hair follicle bulbitis produces focal, multifocal to widespread hair loss. The skin is otherwise normal. Diseases that can mimic the widespread hair loss associated with alopecia areata include telogen and anagen effluvium, seasonal alopecias, follicular dysplasias (including color dilution alopecia), various nutritional deficiencies and chemical toxicosis, and diseases that result in defective hair shafts (eg, trichorrhexis nodosa and piedra). These problems are differentiated by history, physical examination, trichography, and skin biopsy. Most are cosmetic diseases that do not have predictably effective therapies.

Sir, A 10-month-old, 7.4 kg, newly diagnosed hypothyroid infant (thyroid profile showed T3 0.25 ng/mL, T4 1.2 μg/dL, TSH 150 μIU/dL] [Figure 1a] was started on levothyroxine 100 μg/day (14 μg/kg/day). Sonography of the neck showed hypoplasia of thyroid gland. Antiperoxidase and antithyroglobulin antibodies were negative. Ten days after starting levothyroxine, the baby presented with sudden onset, diffuse of loss of scalp hair. The remaining hairs were thin and easily pluckable. On examination, infant had non-scarring alopecia involving 90% of the scalp area without the exclamation mark appearance [Figure ​[Figure1b1b and ​andc].c]. Thyroxine overdose was suspected as the cause of anagen effluvium. At this stage the serum T4 level was very high (Serum T4 = 18.2 μg/dL, TSH = 0.72 μIU/dL), suggesting hyperthyroidism. Levothyroxine dose was reduced by 50% to 50 μg/day. A follow up after 15 days showed dramatic regrowth of hairs [Figure 1d]. Six weeks later, T4 level was still slightly high and therefore the dose was decreased to 37.5 μg/day (5 μg/kg/day). In the follow ups (T4 = 9 μg/dL) scalp hair growth was normal without further hair loss [Figure ​[Figure1e1e and ​andff]. Figure 1 Sequence of events and action. (a) At the time of diagnosis as hypothyroidism, before starting thyroxine. (b) After 20 days of 100 μg/day levothyroxine, on thyroxine 100 μg/day. (c) After 20 days of 100 μg/day levothyroxine, on ... Normally, human hair growth and maintenance depends on three phases of their growth cycle: Anagen, catagen, and telogen. Most hair follicles would be in anagen at any given time, which is the mitotically active and growing stage.[1] Common causes of diffuse scalp hair loss are shown in Table 1. Medications can cause two types of hair loss, telogen effluvium and anagen effluvium. Telogen effluvium is the most common form and usually appears within two to four months after medication. Anagen effluvium occurs within a few days to weeks after medication, as in our patient. The severity of medication-induced hair loss depends on the type and dosage. When we diagnosed hypothyroidism in our child, scalp hair was absolutely normal in texture and distribution [Figure 1a]. Our case developed diffuse hair loss, which was secondary to overdose of levothyroxine; hair loss occurred within a few days of starting treatment and also reversed after correcting the dose [Figure ​[Figure1b1b–d]. Diffuse alopecia areata is another cause of rapid, diffuse hair loss without any clinical inflammatory signs. Well-circumscribed round to oval patches of hairless skin interspersed with normal hair will be seen. Exclamation point hairs is characteristic of alopecia areata, which was not present in our case.[2] Clinically both hyper- and hypothyroidism are associated with hair loss.[3] In hypothyroidism, hair becomes dry, coarse, brittle, increasingly thinner, and slow growing. The relative proportions of telogen compared with anagen hairs in the scalp increase in patients with hair loss.[4] Confusingly, hyperthyroidism can also lead to hair loss where the scalp hair is often fine, soft, greasy, reduced hair shafts tensile strength together with thinned hair shaft diameter despite an apparently increased hair matrix proliferation.[4,5] Ahsan et al. demonstrated thyroid receptors in human hair follicles and through these receptors, thyroid hormone can exert a direct effect on hair follicles.[4] It is very difficult to explain why both hypo- and hyperthyroid states are associated with substantial hair loss.[3] T3 at both lower and higher levels is not suitable to promote the proliferation and/or metabolism of hair follicles. Probably the magnitude of the effects of thyroid hormone on hair growth is variable, and its expression may be influenced by local factors and/or other hormones.[4] Our child developed diffuse hair loss within two weeks of starting levothyroxine, when the estimated T4 and T3 levels were high. After decreasing the levothyroxine dose, there was a dramatic improvement in the scalp hair growth, suggesting anagen effluvium. Scalp hair growth was absolutely normal in texture and distribution while on thyoxine maintenance dose. To conclude, hair follicles need adequate and correct levels of thyroxine to have appropriate hair growth and all children on levothyoxine should be monitored for serum levels of T3 and T4. Table 1 Common causes of diffuse scalp hair loss Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

The skin and the eyes are prone to radiation-induced injury in fluoroscopic procedures. The degree of injury is related to various exposure and patient-related factors. We report a man who presented with an alopecic patch on the left occipital scalp following an extended fluoroscopically-guided endovascular procedure. He subsequently experienced complete hair regrowth, but was later diagnosed with a cataract in his left eye. To our knowledge this is the first report of both anagen effluvium and cataract development in a patient following fluoroscopic radiation exposure. It is important for dermatologists to be aware of these mucocutaneous side effects of radiation exposure to ensure proper management.

Chemotherapy used in the treatment of malignancies produces multiple mucocutaneous adverse reactions that may be clinically challenging. These mucocutaneous reactions are common and sometimes not diagnosed. The objective of this study was to determine the clinical patterns of the mucocutaneous manifestations during and after chemotherapy in children with a hematologic malignancy and to determine whether nutritional status influences the clinical presentation. We recruited patients aged 6 months to 16 years diagnosed with leukemia and lymphoma from a pediatric hematology outpatient clinic between November 2008 and May 2010. The patients were divided into two groups: Group 1, recently diagnosed patients, included in the study before receiving chemotherapy, and Group 2, patients in surveillance who had not had chemotherapy for at least 3 months. A dermatologic examination was performed, and biopsy and mycological and bacteriological tests were conducted if necessary, with 6 months of follow-up. We evaluated 89 patients and included 65 in the study: 40 boys and 25 girls with an average age of 8.3 years. All patients had skin lesions at some time during their baseline assessment or follow-up. The manifestations found were anagen effluvium, xerosis, and acral hyperpigmentation. To our knowledge, this is the first comparative study of skin manifestations associated with chemotherapy in a Mexican pediatric population. The mucocutaneous manifestations associated with chemotherapy are important causes of morbidity. All of the children in our study had skin lesions on assessment. We did not find an association between skin manifestations and nutritional status.

Anagen effluvium due to chemotherapy is usually reversible with complete hair regrowth. However, there is increased evidence that certain chemotherapy regimens can cause dose-dependent permanent alopecia. The histological features of this type of alopecia and the mechanisms of its origin are not known yet. We discuss the histological features of 10 cases of permanent alopecia after systematic chemotherapy with taxanes (docetaxel) for breast cancer (6 patients), busulfan for acute myelogenous leukemia (3 patients), and cisplatin and etoposide for lung cancer (1 patient). All patients had moderate to very severe hair thinning, which in 4 cases was more accentuated on androgen-dependent scalp regions. Patients complained that scalp hair did not grow longer than 10 cm and showed altered texture. Paired scalp biopsies from the affected scalp areas were obtained and evaluated in serial horizontal and vertical sections. The histology of all specimens was characterized by a nonscarring pattern with a preserved number of follicular units and lack of fibrosis. The hair count revealed decreased number of terminal hairs, increased telogen hairs, and increased miniaturized vellus-like hairs with a terminal to vellus and anagen to telogen ratios of 1:1 and 3.6:1, respectively. There was increased number of fibrous streamers (stelae) in both reticular dermis and subcutis. Arao-Perkins bodies were found in the subcutaneous portions of the streamers. The histological findings of permanent alopecia after chemotherapy are those of a nonscarring alopecia similar to androgenetic alopecia. Dermatopathologists should be aware of this condition as the absence of fibrosis and the presence of miniaturized hairs may be considered as features consistent with a diagnosis of androgenetic alopecia. Hence, these cases could easily be misdiagnosed in the absence of a good clinicopathological correlation.

Several patterns of hair loss can occur in lupus erythematosus (LE). Alopecias which show histological characteristics of LE are LE-specific, and include discoid LE (DLE), diffuse or patchy hair loss in acute LE, subacute cutaneous LE, and rarely tumid LE. Lupus hair in SLE is a poorly characterised entity and may be a form of telogen effluvium. Alopecia areata can coexist with LE and may mimic DLE. Non-lupus alopecias such as telogen effluvium and anagen effluvium have a myriad of causes which include disease flares, drugs and stress in the setting of LE. The latest validated Systemic Lupus International Collaborating Clinics classification criteria for SLE includes non-scarring alopecia as a criterion; therefore, recognising the aetiology of hair loss in the setting of LE is crucial in classifying a patient to have systemic disease.

The hair and nails are rapidly growing structures and as such their cell division can be interrupted by disease states and iatrogenic treatments. Other internal diseases can alter the structure and color of the hair and nails. These alterations in the hair and nails supply important information to the physician regarding the underlying diagnosis.

In this article, the nail, hair, and pigment changes caused by systemic diseases will be reviewed. Among the subjects discussed are abnormalities of shape, attachments, surface, and color of the nails; hair alterations such as telogen and anagen effluvium, scarring alopecia, hypertrichosis, and hirsutism; and pigment changes due to connective tissue disorders, sarcoidosis, and metabolic and endocrinologic diseases, among others.

Drugs may cause hair loss, stimulate hair growth, or induce changes in the hair shape and color. Drug-induced hair loss is, in most cases, a consequence of a toxic effect of the drug on the hair matrix. Although a large number of drugs have been occasionally reported to produce hair loss, the relationship between drug intake and hair loss has been proven only for a few agents. Type of hair loss (telogen effluvium, anagen effluvium, or both) depends on the drug, its dosage, and patient's susceptibility. Drug-induced hair loss is usually reversible.

Background: Anagen effluvium is a common side effect of chemotherapy, but few studies have examined its clinical characteristics. Objective: This study was aimed at evaluating the hair loss caused by chemotherapeutic agents. Methods: Sixty-four patients with anagen effluvium were evaluated in the study. Chemotherapeutic agents were classified into 5 different groups. The pattern of hair loss was analyzed when specific involvement of the hairline was obvious. Results: Forty-six (71.9%) of the 64 total patients maintained hairs along their hairline. Hairs were maintained with a total hairline in 20 (31.3%), frontal hairline in 13 (20.3%) and occipital hairline in 12 (18.8%) patients. Among the 20 males with patterned hair loss, the following hairlines were preserved: occipital in 10 (50%), total in 7 (35%) and frontal in 3 (15%). Among the 25 females with patterned hair loss, hairlines were preserved as total in 13 (52%), frontal in 10 (40%) and occipital in 2 (8%). However, no significant differences were detected in hair loss patterns according to age, associated symptoms, chemotherapeutic agent group or combination of chemotherapeutic agents. Conclusion: Our results suggest that anagen effluvium induced by chemotherapeutic agents represents patterned hair loss.

Hair loss is a common complaint, and an understanding of the hair cycle is vital in order to interpret whether hair loss is secondary to medication use, as the use of prescription medications is widespread. When there is a temporal association between the onset of hair loss and the commencement of a medication, the medication is commonly presumed to have caused the hair loss. Drug-induced alopecia is a result of either rapid termination of the normal growth phase (anagen effluvium) or a premature conversion of actively growing hairs into the dormant, resting phase (telogen effluvium). Hair loss, in particular telogen effluvium, may, however, occur in response to a number of triggers including fever, hemorrhage, severe illness, and stress. Because hair loss is often delayed and because diffuse alopecia often begins sub-clinically, it may be challenging to determine the primary of alopecia. As a rule of thumb, adverse drug reactions are reversible provided the causative drug is avoided; however, identifying the culprit medication can be difficult. This chapter will review the normal hair cycle and discuss the major drugs that have been associated with alopecia, along with their mechanism (s) of action.

WOS: 000352233600005, PubMed: 25821474, Introduction: Various types of dermatological manifestations have been reported due to hepatitis C virus (HCV) infection and anti-HCV therapy. Some of them have been described during IFN-based therapies. PEG-IFN-alpha-2a/RBV combination is used as the international standard of treatment for HCV infection for a long time. The combination therapy yields an adverse-event profile similar to standard interferon (IFN) therapy. Some of these adverse effects are rheumatologic, neuropsychiatric and dermatological manifestations including alopecia. Case Presentation: We reported a 43-year-old woman with dystrophic anagen effluvium (DAE), rheumatoid arthritis and Hashimoto thyroiditis, which were developed under the combination therapy for chronic HCV infection. Conclusions: Although some cases of alopecia areata (AA) and telogen effluvium (TE) were reported in literature, no case of DAE associated with PEG-INF-alpha-2a/RBV combination therapy was reported previously.

In this chapter, we will discuss the most common alopecias due to drugs and other skin and systemic disorders. The following hair disorders will be analyzed: telogen effluvium (acute and chronic); anagen effluvium; folliculotropic mycosis fungoides; and folliculitis due to bacteria, fungi, parasites, human immunodeficiency virus disease, lupus erythematosus, and sarcoidosis. We will cover topics including the epidemiology, etiology, clinical picture, and diagnosis of and current treatments for each disease.

Drugs may induce hair loss, stimulate hair growth or, more rarely, induce changes in the hair shape and colour. Drug-induced hair loss is usually completely reversible and is, in most cases, a consequence of a toxic effect of the drug on the hair follicle matrix. In rare cases alopecia may be permanent. Depending on type of drug, dosage and patient susceptibility, hair loss presents as telogen effluvium, anagen effluvium or both. Telogen effluvium is also commonly observed after discontinuation of drugs that prolong anagen, such as topical minoxidil and oral contraceptives. Although a large number of drugs have been occasionally reported to produce hair loss, only for a few drugs the relation between drug intake and hair loss has been proven.

Summary Background Hair loss from cytotoxic drugs is classically ascribed to the loss of fractured hairs (anagen effluvium). Telogen hair loss has also been described but some authors have denied any effect on the hair cycle. There are conflicting reports on a protective effect of pretreatment with a vitamin D analogue on cytotoxic drug-induced hair loss in rodents. Objectives To investigate the process of cytotoxic hair loss and any protective effect on the hair of pretreatment with topical calcipotriol. Methods Breast cancer patients who were about to receive cycles of chemotherapy with cyclophosphamide 600 mg m−2, methotrexate 40 mg m−2 and 5-fluorouracil 600 mg m−2 were recruited and randomized to receive calcipotriol scalp solution 50 µg mL−1 or vehicle. The solution was applied twice daily from 4 days prior to chemotherapy and continued for 14 days in each treatment cycle. Shed, plucked and cut hairs were sampled. Absolute shed rates, the proportion of major hair types, the presence of proximal hair shaft changes, regrowth (using the new anagen hair count) and hair density were assessed. Results Ten patients receiving calcipotriol and 14 receiving vehicle completed three treatment cycles and nine from both groups completed six cycles. There was no detectable effect of calcipotriol on the proportion of patients experiencing minimal hair loss from chemotherapy, shed rates, plucked telogen and fractured hair counts, the morphology of shed and plucked hair, hair regrowth or hair density. Combining results of the treatment groups, there was a large variation in the impact of chemotherapy on hair loss, from total loss in five patients to no obvious loss in five. Excluding the latter, during chemotherapy shed telogen hairs (mean 81% of shed hairs) predominated over fractured (12%) and anagen hairs (6%) (P = 0.0002). The major pathological change was proximal hair shaft tapering, baseline mean 3% of shed hairs rising to 48% (P = 0.0005) during treatment, and there was a consequent decrease in normal telogen hairs, baseline mean 98% of all telogen hairs falling to 55% (P = 0.0005) during treatment. The pathological tapered telogen hairs had normal or small, sometimes diminutive, bulbs. Fracturing of hairs with diminutive bulbs produced typical ‘exclamation mark’ hairs. Conclusions The cardinal effects of cytotoxic drugs found in this study were tapering of the proximal hair shaft and premature entry of the follicle into telogen, conflicting with the conventional view that affected hair follicles continue in anagen. There was a resulting effluvium of a mixture of tapering telogen hairs and fractured hairs. As entry into telogen is an integral part of the process, cytotoxic hair loss may be regarded as a variant of the conventional ‘telogen effluvium’ and we propose the term ‘atrophic telogen effluvium’. There was no obvious protective effect on the hair loss of prior treatment with topical calcipotriol.

Dear Editor, A 66-year-old male patient presented to our department due to vesiculobullous skin lesions over the entire palms and soles that had rapidly progressed over three days. He was treated with topical corticosteroids and oral antihistamines at a private clinic; however, the skin lesions were refractory to the treatments, and the patient developed additional symptoms of fever and myalgia. His medical history revealed that he had been treated with daily olmesartan 20 mg and amlodipine 5 mg for hypertension, which had not been changed for over a year. During the previous two weeks, he had been ingesting Ganoderma lucidum, which his wife and son had also ingested. On physical examination, his body temperature was 38.4 °C, and extensive vesiculobullous lesions with sloughing epidermis were noted on the erythematous palms and soles (Fig. 1). In addition, diffuse alopecic patches over the entire scalp and a positive hair pull test with numerous anagen hairs were noted. Routine laboratory tests were performed, and a biopsy specimen was obtained from an erythematous, but nonvesiculobullous, hand lesion. Complete blood count revealed severe leucopenia of 190 cells/μL (normal range 4,000–10,800 cells/μL; neutrophils 13.6 %, lymphocytes 82.7 %, monocytes 1 %, eosinophils 1 %, and basophils 0.6 %), thrombocytopenia of 36,000 cells/μL (normal range 150,000–400,000 cells/μL), mild anemia of 12.2 g/dL (normal range 13.0–17.0 g/dL), and reticulocyte count of 0.98 % (normal range 0.5–2.31 %). Other laboratory tests were unremarkable. Skin biopsy of the palm revealed mildly infiltrated inflammatory cells adjacent to the dilated capillaries in the upper dermis (Fig. 2a, b). Further investigation for the evaluation of pancytopenia revealed nearly acellular marrow and panhypoplasia without remarkable abnormal cells or blasts (Fig. 2c, d). Klebsiella pneumoniae was isolated from a blood culture. Additional tests, including computed tomography, were performed to rule out Bazex acrokeratosis paraneoplastica. Although there were no remarkable findings suggestive of malignancy, pulmonary angioinvasive aspergillosis forming multifocal areas of lobular and subsegmental consolidation was detected. The patient was diagnosed with G. lucidum-induced aplastic crisis, and pancytopenia was treated with a transfusion of platelet concentrates and subcutaneous filgrastim injection. For the skin lesions of the palms and soles, topical corticosteroid and emollient creams were applied to alleviate the burning sensation. The patient was discharged after five weeks of systemic antifungal and antibacterial therapy, and his complete blood count was normalized at follow up. His hands and feet completely recovered and his scalp hair grew back completely. Routine laboratory tests were also performed for his wife and son, who had also been ingesting G. lucidum. His wife complained of fever and myalgia; however, no skin lesions of the palms or soles or hair loss were noted. Her body temperature was 39.0 °C and complete blood count revealed leucopenia of 830 cells/μL (neutrophils 4.2 %, lymphocytes 79.1 %, monocytes 0.7 %, eosinophils 8.8 %, and basophils 0.4 %), thrombocytopenia of 43,000 cells/μL, anemia of 8.8 g/dL, and reticulocyte count of 0.34 %. Other laboratory tests were unremarkable, with the exception of elevated liver enzyme levels with AST of 213 IU/L (normal range: M. J. Choi :D.-Y. Kim : S. B. Cho (*) Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea e-mail: drsbcho@gmail.com

We present a case of a 17-year-old girl admitted to the Psychiatric Department recovering from a suicide attempt with colchicine. One week after poisoning, a sudden onset of hair loss was observed. Positive hair pull test and trichoscopy demonstrated the presence of anagen hairs with pigmented long roots covered by the root sheaths. Colchicine poisoning is an uncommon, but potentially life-threatening toxicologic emergency. An overdose of colchicine inhibits cell division, and thus the most affected organs are those which have a high rate of cell turnover. Hair loss resulting from colchicine poisoning presents as anagen effluvium, as it occurs with an exposure to toxic chemicals. Pharmacotherapy or specific treatment is not usually required, since the follicle resumes its normal activity after withdrawal of the antimitotic factors.